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  • Michael Frey, MD

Hormones and your weight

Prepare for a wild understatement: Hormones affect your weight!


Hormones: it can be difficult to pinpoint which one is out of whack. For what it's worth, hormones work together in a symphony, so it's unlikely you have an imbalance with just one. When out of balance, hormones keep you from burning fat, so it's important to understand what's going on under the hood.

Things get worse after menopause. The decline in key sex hormones like estrogen and testosterone is the main reason for weight gain in menopause. These hormones regulate metabolism and signal fat breakdown.



The infamous stress hormone cortisol can stimulate a ​​blood sugar roller coaster, which tells your body that you need to eat—and right now. This, in turn, can turn insulin secretion on overdrive, which makes you store fat. Estrogen and progesterone play a role, too. Estrogen dominance (where your body is either producing too much estrogen or you're not getting rid of it properly) can contribute to weight loss resistance, and a drop in progesterone leads to an increased appetite.




SO WHAT CAN YOU DO?


Eat smarter It’s sad but true: As you get older, your body doesn’t need as many calories to maintain your weight. That means you need to eat less just to stay where you are. However, a few simple tips can help you adjust your calorie intake without making drastic changes. Add more whole fruits, vegetables and grains to your diet, and reduce the amount of juice, processed foods and refined grains, such as white bread and white rice. Practice portion control; you may find you are satisfied with smaller meals instead of the big ones you’re used to.


Cruciferous vegetables can help you with liver detoxification, and getting allium vegetables (things like garlic, leeks, and onion) helps you with making glutathione, which is part of this process of mopping up the toxins.


Cruciferous vegetables help break estrogen down, which helps with detoxification. These vegetables, including the alliums, also support liver detoxification by increasing glutathione production, an antioxidant that's also important for reducing oxidative stress.


Low-carb diets

Low-carb diets can affect hormonal imbalance in a positive way. I know a lot of patients who try the keto diet and have a lot of success but it seems too restrictive to me. I prefer the Mediterranean diet. It is less restrictive and seems a healthier alternative. Hydration is also critical to maintaining weight as we age.


Intermittent Fasting

One strategy to eating less is to not eat or “fast” for certain periods of time. According to a Harvard review article intermittent fasting can change body composition through loss of fat mass and weight.

Three ways to do this:

  • Alternate day fasting — Alternating between days of no food restriction with days where you eat only one meal a day at 25% of daily calorie needs. Example: Mon-Wed-Fri consists of fasting or 400-500 calories a day, while alternate days have no food restrictions. This to me sounds sadistic and preposterous. So, no…

  • Whole-day fasting — 1-2 days per week of complete fasting or up to 25% of daily calorie needs, with no food restriction on the other days. Example: The 5:2 diet approach means no food restriction five days of the week, cycled with a 400-500 calorie diet the other two days of the week.

  • Time-restricted feeding — This was my choice. Eating only during a designated window of time and technically fasting all the other hours of the day.



Get Moving You don’t need hours of exercise to get the benefits. That is you don’t need to do it all at once. The Centers for Disease Control and Prevention (CDC) recommends 150 minutes a week of aerobic exercise for adults. That means you can spread your activity out during the week. You can break it up into smaller chunks of time during the day. Strength training can help you build and maintain muscle and bone mass, which is especially important since you lose them as you age. The more muscle mass you have, the more calories your body uses even at rest.

Get support Find a sport, exercise, or physical activity that you enjoy doing and recruit a friend to join you, and you’ll be more likely to do it. If losing weight by eating healthier is your goal, you can find support for that too. Joining a weight-loss program, such as Weight Watchers or Noom Weight, can help with accountability and learning behavioral changes and healthy habits.


Mount Sinai has many weight management centers.


Hormone therapy

Hormones with estrogen, progesterone, and testosterone. Some research suggests that hormones can help women improve muscle mass, increase metabolism and lose weight. In my experience as a prescriber of hormones is that about 20% of women achieve improvement in weight as a result of hormones alone. It is a big win for many other issues, but weight loss is not necessarily a slam dunk.


AGING AND MUSCLE LOSS

Aging leads to the loss of muscle and increased fat. Women lose 3-8% of muscle every decade after 30 years of age. Ways to maintain your muscle are to exercise and get enough protein in your diet. Also, hydration and getting enough sleep are critical to maintaining muscle mass.


THE TAKEAWAY

  • You do have to reduce the calories that you have always eaten in the past if you want to maintain your weight.

  • You do have to choose a nutrition plan you can stick to.

  • You do have to hydrate.

  • You do have to exercise.

  • You do have to balance your hormones — namely insulin and cortisol and consider balancing estrogen, progesterone, and testosterone.

  • You do have to get plenty of sleep, 7 to 8 hours at least a night.


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